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Dhinakaran R, Verma A, Thukral A, Sankar MJ, Agarwal R, Mathur P, Sharma AK, Dar L, Brijwal M, Choudhary A, Deorari A. Vertical Transmission of COVID-19 Infection in a Tertiary Hospital in India - A Prospective Study. Indian J Pediatr 2023; 90:1045. [PMID: 37354345 DOI: 10.1007/s12098-023-04727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Affiliation(s)
- R Dhinakaran
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre (NHKC), All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
| | - Ankit Verma
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre (NHKC), All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
| | - Anu Thukral
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre (NHKC), All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India.
| | - M Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre (NHKC), All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
| | - Ramesh Agarwal
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre (NHKC), All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
| | - Purva Mathur
- Department of Lab Medicine, Jai Prakash Narayan Apex Trauma centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
| | - Aparna K Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
| | - Lalit Dar
- Division of Virology, Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
| | - Megha Brijwal
- Division of Virology, Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
| | - Aashish Choudhary
- Division of Virology, Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
| | - Ashok Deorari
- Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttarakhand, India
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Grover A, Bhargava B, Srivastava S, Sharma LK, Cherian JJ, Tandon N, Chandershekhar S, Ofrin RH, Bekedam H, Pandhi D, Mukherjee A, Dhaliwal RS, Singh M, Rajshekhar K, Roy S, Rasaily R, Saraf D, Kumar D, Parmar N, Kabra SK, Chaudhry D, Deorari A, Tandon R, Singh R, Khaitan B, Agrawala S, Gupta S, Goel SC, Bhansali A, Dutta U, Seth T, Singh N, Awasthi S, Seth A, Pandian J, Jha V, Dwivedi SK, Tripathi R, Thakar A, Jindal S, Gangadhar BN, Bajaj A, Kant M, Chatterjee A. Developing Standard Treatment Workflows-way to universal healthcare in India. Front Public Health 2023; 11:1178160. [PMID: 37663866 PMCID: PMC10472454 DOI: 10.3389/fpubh.2023.1178160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/22/2023] [Indexed: 09/05/2023] Open
Abstract
Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.
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Affiliation(s)
- Ashoo Grover
- Division of NCD, Indian Council of Medical Research, New Delhi, India
| | - Balram Bhargava
- Department of Cardio Neuro Centre, Indian Council of Medical Research, New Delhi, India
| | - Saumya Srivastava
- Division of NCD, Indian Council of Medical Research, New Delhi, India
| | | | | | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Deepika Pandhi
- Department of Dermatology, University College of Medical Sciences, New Delhi, India
| | - Aparna Mukherjee
- Division of ECD, Indian Council of Medical Research, New Delhi, India
| | | | - Manjula Singh
- Division of ECD, Indian Council of Medical Research, New Delhi, India
| | | | - Sudipto Roy
- Indian Council of Medical Research, New Delhi, India
| | - Reeta Rasaily
- Division of NCD, Indian Council of Medical Research, New Delhi, India
- Division of BMI, Indian Council of Medical Research, New Delhi, India
| | - Deepika Saraf
- Department of Paediatrics, AIIMS, New Delhi, India
- Department of Pulmonology, PGIMER, Chandigarh, India
| | - Dhiraj Kumar
- Indian Council of Medical Research, New Delhi, India
| | - Neeraj Parmar
- Indian Council of Medical Research, New Delhi, India
| | | | - Dhruva Chaudhry
- Pandit Bhagwat Dayal Sharma PG Institute of Medical Sciences, Rohtak, India
| | - Ashok Deorari
- Himalayan Institute of Medical Sciences, Baksar Wala, Dehradun, India
| | - Radhika Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Binod Khaitan
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Anil Bhansali
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Haematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Seth
- All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- All India Institute of Medical Sciences, New Delhi, India
| | - Shally Awasthi
- Department of Paediatrics, King George's Medical University, Lucknow, India
- Department of Urology, King George's Medical University, Lucknow, India
- Department of Neurology, King George's Medical University, Lucknow, India
- Department of Nephrology, King George's Medical University, Lucknow, India
- Department of Cardiology, King George's Medical University, Lucknow, India
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, India
- Department of ENT, King George's Medical University, Lucknow, India
- Department of Pulmonology, King George's Medical University, Lucknow, India
- Department of Psychiatry, King George's Medical University, Lucknow, India
- Department of Gastroenterology, King George's Medical University, Lucknow, India
| | - Amlesh Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India
| | | | | | - Alok Thakar
- All India Institute of Medical Sciences, New Delhi, India
| | - Surinder Jindal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anjali Bajaj
- Government of Himachal Pradesh, Himachal Pradesh, India
| | - Mohan Kant
- Department of Paediatrics, Indian Council of Medical Research, New Delhi, India
- Department of Opthalmology, Indian Council of Medical Research, New Delhi, India
- Department of General Surgery, Indian Council of Medical Research, New Delhi, India
- Dermatology, Indian Council of Medical Research, New Delhi, India
- Paediatric Surgery, Indian Council of Medical Research, New Delhi, India
- Oncology, Indian Council of Medical Research, New Delhi, India
- Orthopaedics, Indian Council of Medical Research, New Delhi, India
- Endocrinology, Indian Council of Medical Research, New Delhi, India
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Thomas D, Anand P, Thukral A, Agarwal R, Deorari A, Sankar MJ. Secular Trends in Birthweights in Two Epochs Over 40 Years in a Tertiary Care Center. Indian Pediatr 2022; 59:603-607. [PMID: 35642924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare the average birthweights and the weight centiles of the 'new' growth charts with the 'old' (1974) charts developed in the same unit four decades ago. METHODS Birthweight and gestation data of the eligible 12,355 singleton neonates born between 2009 and 2016 at a level-3 neonatal unit at a public sector hospital were used to develop the new growth chart. We then compared the prevalence of small for gestational age (SGA) and large for gestational age (LGA) classified by the new charts and the old charts, the incidence of short-term adverse outcomes among them, and the diagnostic performance of both the charts to identify the adverse outcomes in a separate validation cohort. RESULTS The mean birthweights of boys and girls across all gestations were higher by 150-200 g and 100-150 g, respectively, in the new chart. The prevalence of SGA doubled (9.8% vs 4.7%), but LGA decreased by one-third (17.5% vs 25.9%) with the new chart. However, the proportion of SGA and LGA having one or more short-term adverse outcomes, and the diagnostic performance of both the charts to identify neonates with short-term adverse outcomes, were comparable. CONCLUSION There was an upward shift in the birthweights by about 150 g across all gestations in the new chart compared to the old chart developed 40 years ago. The findings imply the need to consider using updated growth charts to ensure accurate classification of size at birth of neonates.
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Affiliation(s)
- Deena Thomas
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
| | - Pratima Anand
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
| | - Anu Thukral
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
| | - Ramesh Agarwal
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
| | - Ashok Deorari
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
| | - M Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi. Correspondence to: Dr M Jeeva Sankar, Additional Professor, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
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Gopinath B, Kumar A, Sah R, Bhoi S, Jamshed N, Ekka M, Aggarwal P, Deorari A, Bhargava B, Kappagantu V. Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India. BMJ Open Qual 2022; 11:bmjoq-2021-001764. [PMID: 35914815 PMCID: PMC9345032 DOI: 10.1136/bmjoq-2021-001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background ST-elevation myocardial infarction (STEMI) is a highly time-sensitive and life-threatening condition. Early recognition and timely management are challenging in a busy emergency department (ED), especially in low/middle-income countries where emergency systems are often fragmented. The aim of our quality improvement (QI) project was to increase the percentage of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with door to balloon (D2B) time of <90 min by 30% over 12 months. Methods As part of the first step in QI, baseline data were collected at different points in the process of care. Using process maps and fishbone analysis, delays in patient registration, ECG and communication with cardiology were identified as some bottlenecks, and change ideas were tested using plan–do–study–act cycles using point-of-care QI methodology. The majority of the change ideas focused on interventions in the ED like strengthening triage, training frontline staff, early diagnosis and quick transportation of patients. Results During the baseline phase, 22.22% of patients were found to have a D2B time of <90 min. We achieved an increase of 47.78% in patients receiving PCI within 90 min and hence increased to 70% at the end of the intervention phase. Data collected for 4 months after the intervention phase were found to have sustained the effort. Conclusion Significant improvement in the door to reperfusion time resulted from a meticulous assessment of emergency care processes by drawing process flow chart and implementation of change ideas like introduction of fast-track policy for patients with chest pain, reducing staff turnover in the triage area, formal training of staff, continuous engagement with cardiology team and by interchanging of processes which led to a reduction in time to ECG.
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Affiliation(s)
- Bharath Gopinath
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sah
- Department of Emergency Medicine, BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Meera Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Deorari
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Vignan Kappagantu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Thukral A, Deorari A, Chawla D. Periodic change of body position under phototherapy in term and preterm neonates with hyperbilirubinaemia. Cochrane Database Syst Rev 2022; 3:CD011997. [PMID: 35235686 PMCID: PMC8890478 DOI: 10.1002/14651858.cd011997.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Phototherapy is the mainstay of treatment of neonatal hyperbilirubinaemia. Periodic change in position of the neonate under phototherapy (from supine to prone or lateral positions) may improve the efficiency of phototherapy by hastening the access of phototherapy light to bilirubin deposited in different parts of the skin and subcutaneous tissue. OBJECTIVES To evaluate the effects of periodic change of body position during phototherapy as compared to no prescribed change in body position, on serum total bilirubin level and duration of treatment in neonates with unconjugated hyperbilirubinaemia during the first 28 days of life. Secondary objectives of the review included evaluation of the efficacy of periodic change of body position on the need for or number of exchange transfusions, incidence of bilirubin-induced neurological damage (BIND), side effects of phototherapy, and sudden infant death syndrome (SIDS). SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to run comprehensive searches in the Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 3) in the Cochrane Library and Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions on 5 March 2021. We also searched clinical trials databases and the reference lists of included studies and relevant reviews for randomised controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA We included RCTs and quasi-RCTs if they enrolled neonates (term and preterm) of either gender with unconjugated hyperbilirubinaemia requiring phototherapy and compared periodic change of the body position of the infant under phototherapy with no prescribed change in body position. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data, consulting with a third review author in the case of disagreement. We used standard Cochrane methodological procedures, including assessing the risk of bias of included studies. We used the GRADE approach to assess the certainty of evidence. Primary outcomes were the duration of phototherapy and rate of fall of serum bilirubin at 24 hours. Secondary outcomes included the need for exchange transfusion, number of exchange transfusions, incidence of BIND, and SIDS. MAIN RESULTS We included five studies (343 neonates) with an overall high risk of bias in the review. The body position under phototherapy was changed every two hours or every two-and-a-half hours in two studies each, and every three hours in one study. Three of the five studies included healthy term neonates, whilst the other two studies also included preterm neonates (≥ 33 weeks' gestation); however, separate data about review outcomes in preterm neonates were not available. Periodic change in body position may lead to little or no difference in the duration of phototherapy (mean difference (MD) 1.71 hours, 95% confidence interval (CI) -3.17 to 6.59 hours; I² = 58%; 4 studies, 231 participants; low certainty evidence). Only one study reported the rate of fall of serum total bilirubin at 24 hours of starting the phototherapy. Periodic change in body position may lead to little or no difference in the rate of fall of serum total bilirubin at 24 hours (MD 0.02 mg/dL/h, 95% CI -0.02 to 0.06 mg/dL/h; 1 study, 100 participants; low certainty evidence). We downgraded the certainty of evidence to low due to risk of bias and imprecision. None of the included studies reported the need for or number of exchange transfusions, incidence of BIND, or SIDS. Lack of separate data precluded subgroup analysis. AUTHORS' CONCLUSIONS The available evidence is insufficient to determine the effects of periodic change of body position compared with no prescribed change of body position under phototherapy. There is low certainty evidence that there may be little or no difference in the duration of phototherapy and rate of fall in bilirubin at 24 hours of starting phototherapy between periodic change in body position and no prescribed change of body position under phototherapy in term and preterm neonates. None of the included studies reported the effect of change of position on the need for or number of exchange transfusions, incidence of BIND, or SIDS. One study is awaiting classification and could not be included in the review. Further studies are needed to evaluate the effect of periodic change in body position under phototherapy, especially in neonates with haemolytic hyperbilirubinaemia and in very preterm neonates. The results of this systematic review apply mainly to neonates born at late-preterm or term gestation receiving phototherapy for non-haemolytic hyperbilirubinaemia.
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Affiliation(s)
- Anu Thukral
- Department of Pediatrics, Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, New Delhi, India
| | - Ashok Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
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Thomas D, Madathil S, Thukral A, Sankar MJ, Chandra P, Agarwal R, Deorari A. Diagnostic Accuracy of WINROP, CHOP-ROP and ROPScore in Detecting Type 1 Retinopathy of Prematurity. Indian Pediatr 2021. [PMID: 34016801 PMCID: PMC8549580 DOI: 10.1007/s13312-021-2321-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Algorithms for predicting retinopathy of prematurity (ROP) requiring treatment need to be validated in Indian settings to determine if the burden of screening can be reduced without compromising the sensitivity of existing gestation and weight-based cut offs. Objective To evaluate the performance of the available algorithms namely, WINROP (Weight, Insulin-like growth factor I, Neonatal ROP), CHOP-ROP (children’s Hospital of Philadelphia ROP) and ROPScore in predicting type 1 ROP and time from alarm to treatment by each algorithm. Study design Ambispective observational. Setting Tertiary care neonatal intensive care unit in India. Participants Neonates less than 32 weeks or less than 1500 g born between July, 2013 to June, 2019 (N=578), who underwent ROP screening. Primary outcome Sensitivity, specificity and time from alarm to treatment by each algorithm. Results The sensitivity and specificity of WINROP was 85% and 36%, for CHOP-ROP it was 54% and 71%, and for ROPScore it was 73% and 67%, respectively in detecting type 1 ROP. A total of 50/51 (98%) of neonates with type 1 ROP underwent treatment at median gestation of 9 weeks and median time from alarm to treatment by WINROP, CHOP-ROP and ROPScore was 7, 7 and 3 weeks, respectively. Conclusion WINROP, CHOP-ROP and ROPScore were not sensitive enough to replace the gestational age, weight and risk factor-based screening criteria for type 1 ROP.
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Madathil S, Thomas D, Chandra P, Agarwal R, Sankar MJ, Thukral A, Deorari A. 'NOPAIN-ROP' trial: Intravenous fentanyl and intravenous ketamine for pain relief during laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants: A randomised trial. BMJ Open 2021; 11:e046235. [PMID: 34531205 PMCID: PMC8449965 DOI: 10.1136/bmjopen-2020-046235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate if intravenous fentanyl or intravenous ketamine can provide adequate analgesia in preterm infants undergoing laser photocoagulation for retinopathy of prematurity (ROP). DESIGN Open-label randomised trial. SETTING Tertiary care institution. PARTICIPANTS Preterm infants who underwent laser photocoagulation for ROP. INTERVENTIONS Infants were randomised to receive fentanyl as intravenous bolus dose of 2 µg/kg, followed by an intravenous infusion of 1 µg/kg/hour increased to a maximum of 3 µg/kg/hour or intravenous ketamine as bolus dose of 0.5 mg/kg, followed by further intermittent intravenous bolus doses of 0.5 mg/kg to a maximum of 2 mg/kg in the initial phase and intravenous fentanyl (bolus of 2 µg/kg followed by infusion of 2 µg/kg/hour to a maximum of 5 µg/kg/hour) or intravenous ketamine (bolus dose of 1 mg/kg followed by intermittent bolus doses of 0.5 mg/kg to a maximum of 4 mg/kg) in the revised regimen phase. MAIN OUTCOME MEASURES Proportion of infants with adequate analgesia defined as the presence of both: (1) all the Premature Infant Pain Profile-Revised scores measured every 15 min less than seven and (2) proportion of the procedure time the infant spent crying less than 5%.Secondary outcomes included apnoea, cardiorespiratory or haemodynamic instability, feed intolerance and urinary retention requiring catheterisation during and within 24 hours following the procedure. RESULTS A total of 97 infants were randomised (fentanyl=51, ketamine=46). The proportions of infants with adequate analgesia were 16.3% (95% CI 8.5% to 29%) with fentanyl and 4.5% (95% CI 1.3% to 15.1%) with ketamine. Ten infants (19.6%) in the fentanyl group and seven infants (15.2%) in the ketamine group had one or more side effects. In view of inadequate analgesia with both the regimens, the study steering committee recommended using a higher dose of intravenous fentanyl and intravenous ketamine. Consequently, we enrolled 27 infants (fentanyl=13, ketamine=14). With revised regimens, the proportions of infants with adequate analgesia were higher: 23.1% (95% CI 8.2% to 50.2%) with fentanyl and 7.1% (95% CI 1.3% to 31.5%) with ketamine. However, higher proportions of infants developed apnoea (n=4; 30.7%), need for supplemental oxygen (n=5, 38.4%) and change in cardiorespiratory scores (n=7; 53.8%) with fentanyl but none with ketamine. CONCLUSIONS Fentanyl-based and ketamine-based drug regimens provided adequate analgesia only in a minority of infants undergoing laser photocoagulation for ROP. More research is needed to find safe and effective regimens that can be employed in resource constrained settings. TRIAL REGISTRATION NUMBER CTRI/2018/03/012878.
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Affiliation(s)
- Shamnad Madathil
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Deena Thomas
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Parijat Chandra
- Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Ramesh Agarwal
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - M Jeeva Sankar
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Anu Thukral
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Ashok Deorari
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
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Parmar J, Pawar V, Warathe A, Singh M, Bajaj R, Kumar J, Thukral A, Chawla D, Kumar P, Deorari A. Rationalising oxygen usage in a level II special newborn care unit in Madhya Pradesh, India. BMJ Open Qual 2021; 10:bmjoq-2021-001386. [PMID: 34344749 PMCID: PMC8336200 DOI: 10.1136/bmjoq-2021-001386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022] Open
Abstract
Non-judicious oxygen use in preterm infants is associated with increased risk of retinopathy of prematurity, bronchopulmonary dysplasia and longer hospital stay. Despite established guidelines on oxygen therapy, compliance with the best oxygen practices remains suboptimal. Excessive use of oxygen also consumes a large proportion of the annual maintenance budget of special newborn care units (SNCUs) in the districts. In this project, we aimed to reduce the oxygen consumption in the SNCU at Sehore, Madhya Pradesh, India from eight to four cylinders per day, by rationalising the indications, monitoring and method of oxygen delivery. We tested two sets of interventions using the Plan–Do–Study–Act (PDSA) approach. The first intervention was the introduction of a written ‘oxygen policy’ regarding indications of starting/stopping oxygen and the use of saturation targets. The second was using short binasal infant prongs (at 0.5–1 L/min), instead of oxygen hoods as the primary method of oxygen delivery in spontaneously breathing neonates requiring oxygen. In the first PDSA cycle, we assessed the feasibility of the intervention in a small set (n=30) of neonates and later scaled up to all eligible neonates in the second phase. We observed a significant reduction in oxygen consumption (from median (IQR) 8 (7–8) to 3 (3–4) cylinders per day) that can lead to a direct saving of 590 000 Indian rupees (US$9000) per year. There was a significant reduction in the number of neonates on oxygen support on a given day. We did not observe any increase in mortality or nasal injury. The change was sustained for the next 8 months. We conclude that by having a contextual oxygen policy and using nasal prongs instead of oxygen hoods as the preferred delivery method, we can achieve a sustainable reduction in oxygen consumption.
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Affiliation(s)
- Jaiprakash Parmar
- Child Health Division, Special Newborn Care Unit, Sehore, Madhya Pradesh, India
| | - Vandana Pawar
- Child Health Division, Special Newborn Care Unit, Sehore, Madhya Pradesh, India
| | - Aarti Warathe
- Child Health Division, Special Newborn Care Unit, Sehore, Madhya Pradesh, India
| | - Manish Singh
- Child Health Division, National Health Mission, Bhopal, India
| | - Rajashree Bajaj
- Child Health Division, National Health Mission, Bhopal, India
| | - Jogender Kumar
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepak Chawla
- Department of Pediatrics, Government Medical College and Hospital (GMCH) - 32, Chandigarh, India
| | - Praveen Kumar
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashok Deorari
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Chinnappan A, Sharma A, Agarwal R, Thukral A, Deorari A, Sankar MJ. Fortification of Breast Milk With Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates: A Randomized Noninferiority Trial. JAMA Pediatr 2021; 175:790-796. [PMID: 33970187 PMCID: PMC8111561 DOI: 10.1001/jamapediatrics.2021.0678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Fortification of expressed breast milk (EBM) using commercially available human milk fortifiers (HMF) increases short-term weight and length in preterm very low-birth-weight (VLBW) neonates. However, the high cost and increased risk of feed intolerance limit their widespread use. Preterm formula powder fortification (PTF) might be a better alternative in resource-limited settings. OBJECTIVE To demonstrate that fortification of EBM by preterm formula powder is noninferior to fortification by HMF, in terms of short-term weight gain, in VLBW neonates. DESIGN, SETTING, AND PARTICIPANTS Open-label, noninferiority, randomized trial conducted from December 2017 to June 2019 at a level 3 neonatal unit in India. The trial enrolled preterm (born at or before 34 weeks of gestation) VLBW neonates receiving at least 100 mL/kg/d of feeds and consuming 75% of milk or more as EBM. INTERVENTIONS Neonates were randomly assigned to receive fortification by either PTF or HMF. Calcium, phosphorus, iron, vitamin D, and multivitamins were supplemented in PTF and only vitamin D in the HMF group to meet the recommended dietary allowances. MAIN OUTCOMES AND MEASURES The primary outcome was the weight gain until discharge from the hospital or 40 weeks' postmenstrual age, whichever was earlier; the prespecified noninferiority margin was 2 g/kg/d. Secondary outcomes included morbidities such as necrotizing enterocolitis, feed intolerance, and extrauterine growth restriction (<10th percentile on the Fenton chart at 40 weeks' postmenstrual age). RESULTS Of the 123 neonates enrolled, 60 and 63 were randomized to the PTF and HMF groups, respectively. The mean gestation (30.5 vs 29.9 weeks) and birth weight (1161 vs 1119 g) were comparable between the groups. There was no difference in the mean (SD) weight gain between the PTF and HMF groups (15.7 [3.9] vs 16.3 [4.0] g/kg/d; mean difference, -0.5 g/kg/d; 95% CI, -1.9 to 0.7). The lower bound of 95% CI did not cross the noninferiority margin. The incidence of feed intolerance was lower in the PTF group (1.4 vs 6.8 per 1000 patient-days; incidence rate ratio 0.19; 95% CI, 0.04 to 0.95), and fewer neonates required withholding of fortification for 24 hours or more (5% vs 22%; risk ratio, 0.22; 95% CI, 0.07 to 0.75). The incidence of necrotizing enterocolitis stage II or more (0 vs 5%) and extrauterine growth restriction (73% vs 81%) was comparable between the groups. CONCLUSIONS AND RELEVANCE Fortification with preterm formula powder is not inferior to fortification with human milk fortifiers in preterm neonates. Given the possible reduction in feed intolerance and lower costs, preterm formula might be a better option for fortification, especially in resource-restricted settings. TRIAL REGISTRATION Clinical Trial Registry, India Identifier: CTRI/2017/11/010593.
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Affiliation(s)
- Arunambika Chinnappan
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Sharma
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Agarwal
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Thukral
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Deorari
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M. Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Sokhal N, Kumar A, Aggarwal R, Goyal K, Soni KD, Garg R, Deorari A, Sharma A. Acute critical care course for interns to develop competence. Natl Med J India 2021; 34:167-170. [PMID: 34825549 DOI: 10.25259/nmji_103_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background All medical graduates must know how to stabilize and manage critically ill patients. A 2-day intensive course, called the acute critical care course (ACCC), was conducted to train interns in technical and non-technical skills for managing a patient whose condition is deteriorating. This analysis aims to assess the feasibility and effectiveness of ACCC for interns. Methods We developed and conducted the ACCC to train interns. It included lectures and skill stations. Twenty-four interns participated in the course. Immediate, post-course, quantitative and qualitative feedback was taken online. Qualitative information was also collected verbally and later by email. These data were analysed both quantitatively and qualitatively. Thematic analysis was used to identify, analyse and report the patterns of responses and behaviour. Results The average score for the utility of the course was 4.7 and for the skill stations it was 4.6 on a scale of 5. The qualitative analysis of the feedback emphasized the need for the course before the clinical posting and more skill-based modules rather than lectures. The interactive style of teaching and training in communication using role-play was appreciated. Few suggestions to improve the course were provided. Conclusions Implementing the ACCC needed simulation, interactive discussions, role-play, modified Pendleton's feedback, and reflective exercise that form the basis of a range of educational principles. The blended learning set of objectives of ACCC were the pillars for this successful internship training programme.
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Affiliation(s)
- Navdeep Sokhal
- Department of Neuroanaesthesia and Critical Care, Jayprakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Akshay Kumar
- Department of Emergency Medicine, Jayprakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Richa Aggarwal
- Department of Critical and Intensive Care, Jayprakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Keshav Goyal
- Department of Neuroanaesthesia and Critical Care, Jayprakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, Jayprakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Care, Dr B.R. Ambedkar Institute-Rotary Cancer Hospital, New Delhi, India
| | - Ashok Deorari
- Department of Paediatrics, Dr B.R. Ambedkar Institute-Rotary Cancer Hospital, New Delhi, India
| | - Ajay Sharma
- Department of Surgery, Wirral Teaching Hospitals, Birkenhead, Liverpool, UK
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Sivanandan S, Deorari A. Antenatal dexamethasone for early preterm birth in low-resource countries. Natl Med J India 2021; 34:164-166. [PMID: 34825548 DOI: 10.25259/nmji_916_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Sindhu Sivanandan
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical, Education and Research, Puducherry, India
| | - Ashok Deorari
- Department of Paediatrics, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India
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Kumar A, Sokhal N, Aggarwal R, Goyal K, Soni KD, Garg R, Bhoi S, Deorari A, Sharma A. Communication skills training through 'role play' in an acute critical care course. Natl Med J India 2021; 34:92-94. [PMID: 34599121 DOI: 10.4103/0970-258x.326757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND . Effective patient-doctor communication is a key component of patient-centred care, which is one of the six pillars of quality healthcare delivery. Structured and effective communication skills training for healthcare providers is the need of hour in medical education. We assessed the efficacy of role play and simulation in developing communication skills. METHODS . As a key component of an acute critical care course (ACCC), communication skills are taught using role play models and simulation. Live feedback is critical in learning during this course as per the principles of adult learning (andragogy). Quantitative and qualitative data were collected to assess the efficacy of ACCC. RESULTS . The 19th ACCC was introduced to interns at the All India Institute of Medical Sciences, New Delhi in December 2018. The teaching methodology and objective-oriented structured training in ACCC were much appreciated for training in human factors with emphasis on communication. A positive response was obtained from the candidates 3 weeks after they completed the course to assess whether interns are able to make use of this training in their day-to-day clinical practice amounting to a reliable evidence level of Kirkpatrick's 'return of investment'. CONCLUSION . The use of 'role play' to teach communication skills is effective and superior to lecture-based teaching. Further structured and interactive programmes in communication skills training will improve patient care, relatives' satisfaction and the image of medical profession.
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Affiliation(s)
- Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Navdeep Sokhal
- Department of Neuroanaesthesia and Critical Care, J.P.N. Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Richa Aggarwal
- Department of Critical Care, J.P.N. Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Keshav Goyal
- Department of Neuroanaesthesia and Critical Care, J.P.N. Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kapil Dev Soni
- Department of Critical Care, J.P.N. Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Care, Dr B.R. Ambedkar Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, J.P.N. Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Ashok Deorari
- Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Ajay Sharma
- Wirral Teaching Hospitals, Core Surgical Training Merseyside, North West of England, University of Liverpool, Liverpool, UK
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Abstract
mHealth, the use of wireless and portable communication technology to improve the health status of the population, has seen widespread adoption in low- and middle-income countries. It has been used to increase awareness and knowledge of healthcare, to collect health-related data, to deliver healthcare information such as results of investigations or appointment reminders, to aid decision-making by healthcare providers, and to improve communication between various stakeholders of the health system. Developing countries face an immense challenge of periodically updating the professional knowledge of their huge pool of community and facility level healthcare workers. Nearly universal possession of mobile phones, low-cost internet data, and high growth rate of smartphones has facilitated the use of mHealth in delivering evidence-based guidelines and decision-aids to frontline healthcare workers. This review describes the current evidence on the use of mHealth educational interventions targeting maternal and neonatal healthcare providers in low- and middle-income countries. Recent efforts of the National Neonatology Forum of India in integration of mHealth for development and dissemination of clinical practice guidelines are also presented.
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Affiliation(s)
- Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Anu Thukral
- Divison of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Kumar
- Divison of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Deorari
- Divison of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Kumar P, Chawla D, Thukral A, Deorari A, Shukla R, Gilbert C. Development of a quality improvement package for reducing sight-threatening retinopathy of prematurity. Indian J Ophthalmol 2020; 68:S115-S120. [PMID: 31937745 PMCID: PMC7001182 DOI: 10.4103/ijo.ijo_2087_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: With improving survival of preterm neonates, retinopathy of prematurity (ROP) is emerging as a major cause of childhood blindness. Incidence of sight-threatening ROP can be reduced by improving the quality of care provided to preterm neonates. Methods: This before-and-after study was designed to develop a need-based intervention package to improve knowledge, skills, and practices of those providing care for preterm neonates, and to evaluate the effectiveness of this package when combined with point-of-care quality improvement (POCQI) in improving survival of preterm neonates without sight-threatening ROP. The study had a formative component to assess baseline knowledge, skills, practices and attitudes, and to assess the needs of the healthcare staff to improve the care of preterm neonates. It was conducted in four special care neonatal units (SCNU) in the state of Madhya Pradesh in India. Results: A theory of change was developed to guide the development of study tools including needs assessment and educational package development. The educational package thus developed has been tested at the study sites in combination with POCQI projects driven by local teams of healthcare providers. The effectiveness of the interventions has been evaluated by collection of individual-level data on neonates admitted at the study sites. Conclusion: A multidimensional educational package integrated with system changes in the form of quality improvement (QI) endeavours driven by local context and needs were developed and evaluated in the project.
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Affiliation(s)
- Praveen Kumar
- Neonatal Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rajan Shukla
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Clare Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Sahoo T, Anand P, Verma A, Saksena M, Sankar MJ, Thukral A, Agarwal R, Deorari A, Paul VK. Outcome of extremely low birth weight (ELBW) infants from a birth cohort (2013-2018) in a tertiary care unit in North India. J Perinatol 2020; 40:743-749. [PMID: 32060359 DOI: 10.1038/s41372-020-0604-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/15/2020] [Accepted: 01/31/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate mortality and short-term morbidities in extremely low birth weight (ELBW) infants (<1000 g) in a birth cohort in North India. METHODS In-hospital data of 231 ELBW infants (Jan 2013 to Sept 2018) were collected from a prospectively maintained electronic database by using standard definitions. RESULTS The mean (SD) gestation and birth weight were 27.9 (2.2) weeks and 783 (133) g, respectively. Major morbidities included respiratory distress syndrome (n = 132, 57%), moderate-to-severe bronchopulmonary dysplasia (n = 62, 26.8%), hemodynamically significant patent ductus arteriosus (n = 65, 28%), intracranial hemorrhage ≥ grade II (n = 38, 16%), and culture-positive sepsis (n = 44, 19%). Median (IQR) duration of hospital stay (survivors) was 50 (17-79) days. The overall survival was 62%. On logistic regression, severe birth asphyxia, gestation ≤26 weeks, and respiratory distress syndrome were major predictors of mortality. CONCLUSION In the current ELBW cohort, nearly two-thirds survived until discharge, who had considerable morbidities needing prolonged hospital stay. This study can be utilized for counseling and planning of care of ELBW infants in similar settings.
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Affiliation(s)
- Tanushree Sahoo
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pratima Anand
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ankit Verma
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manju Saksena
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Mari Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anu Thukral
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ramesh Agarwal
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashok Deorari
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vinod K Paul
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Koganti RA, Deorari A. BEMPU Bracelet: Potentially Useful But Still Requires Robust Validation. Indian Pediatr 2020; 57:292-293. [PMID: 32284473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Raja Ashok Koganti
- Neonatal Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029
| | - Ashok Deorari
- Neonatal Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029.
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Abstract
India is home to largest number of preterm births and neonates at risk of developing retinopathy of prematurity. Being a large heterogenous country, different approaches including training of local ophthalmologists, tele-screening by ophthalmic technicians carrying wide-angle retinal cameras and use of low-cost retinal cameras by neonatal unit healthcare providers are being tested to expand the coverage of screening.
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Affiliation(s)
- Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Ashok Deorari
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
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Kumar A, Lakshminarayanan D, Joshi N, Vaid S, Bhoi S, Deorari A. Triaging the triage: reducing waiting time to triage in the emergency department at a tertiary care hospital in New Delhi, India. Emerg Med J 2019; 36:558-563. [PMID: 31366625 DOI: 10.1136/emermed-2019-208577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Prolonged wait times prior to triage outside the emergency department (ED) were a major problem at our institution, compromising patient safety. Patients often waited for hours outside the ED in hot weather leading to exhaustion and clinical deterioration. The aim was to decrease the median waiting time to triage from 50 min outside ED for patients to <30 min over a 4-month period. METHODS A quality improvement (QI) team was formed. Data on waiting time to triage were collected between 12 pm and 1 pm. Data were collected by hospital attendants and recorded manually. T1 was noted as a time of arrival outside the ED, and T2 was noted as the time of first medical contact. The QI team used plan-do-study-act cycles to test solutions. Change ideas to address these gaps were tested during May and June 2018. Change ideas were focused on improving the knowledge and skills of staff posted in triage and reducing turnover of triage staff. Data were analysed using run chart rules. RESULTS Within 6 weeks, the waiting time to triage reduced to <30 min (median, 12 min; IQR, 11 min) and this improvement was sustained for the next 8 weeks despite an increase in patient load. CONCLUSION The authors demonstrated that people new to QI could use improvement methods to address a specific problem. It was the commitment of the frontline staff, with the active support of senior leadership in the department that helped this effort succeed.
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Affiliation(s)
- Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nitesh Joshi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonali Vaid
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Deorari
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
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Deorari A, Koganti RA. Closing the practice-to-outcome gap: lessons from the BetterBirth study. Lancet Glob Health 2019; 7:e992-e993. [PMID: 31303305 DOI: 10.1016/s2214-109x(19)30280-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ashok Deorari
- Department of Paediatrics, WHO Collaborating Centre for Newborn Training and Research, All India Institute of Medical Sciences, New Delhi 110 029, India.
| | - Raja Ashok Koganti
- Department of Paediatrics, WHO Collaborating Centre for Newborn Training and Research, All India Institute of Medical Sciences, New Delhi 110 029, India
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Natarajan CK, Jeeva Sankar M, Agarwal R, Deorari A, Paul V. Performance on Paladai Feeding of Preterm Infants with Bronchopulmonary Dysplasia. Indian J Pediatr 2019; 86:323-328. [PMID: 30547426 DOI: 10.1007/s12098-018-2818-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/26/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the feeding performance of infants with bronchopulmonary dysplasia (BPD) on paladai. METHODS This cross-sectional study was performed in a level III neonatal unit in North India from March through August 2012. Nineteen infants (27-32 wk of gestation) were enrolled; 9 in BPD group (oxygen requirement for at least 28 d) and 10 in 'No BPD' group. Paladai feeding (PF) sessions were video recorded for 3 d serially, at first successful (FSF) at postnatal age of ≥28 d and follow up feeding (FUF) at 40 ± 2 wk. Successful feeding was defined as ≥80% intake of volume prescribed. One hundred and four videos were analysed (58 in BPD group and 46 in 'No BPD' group). The outcome variables were: (1) postmenstrual age (PMA) at FSF (2) feeding performance, as assessed by proficiency (mL/min, volume of feed intake during only active feeding), efficiency (mL/min, volume of feed intake during total duration of feeding) and overall feed transfer (OT, % of prescribed feed volume taken), and (3) change in heart rate (∆HR) and oxygen saturation (∆SpO2) on PF. RESULTS PMA (Weeks, 34.2 ± 2.0 vs. 33.6 ± 1.2, p = 0.13), performance on FSF [Median (range), Proficiency: ml/min, 4.2 (1.1, 21.7) vs. 3.4 (1.1, 12.4), efficiency: ml/min, 2.7 (0.4, 6.2) vs. 2.5 (0.9, 10.9)] and OT (%, mean ± SD: 84.9 ± 22.5 vs. 89.1 ± 9.6), and on FUF were comparable between the groups. Changes in SpO2 and HR were not significantly different. CONCLUSIONS Infants with BPD perform comparably well on PF. PF can safely be attempted in them to facilitate transition to oral feeding.
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Affiliation(s)
- Chandra Kumar Natarajan
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mari Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ramesh Agarwal
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Ashok Deorari
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vinod Paul
- Division of Neonatology, Department of Pediatrics, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
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Deorari A, Chandra P. Quality improvement: A new paradigm in health care. Apollo Med 2019. [DOI: 10.4103/am.am_20_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jain K, Sankar MJ, Nangia S, Ballambattu VB, Sundaram V, Ramji S, Plakkal N, Kumar P, Jain A, Sivanandan S, Vishnubhatla S, Chellani H, Deorari A, Paul VK, Agarwal R. Causes of death in preterm neonates (<33 weeks) born in tertiary care hospitals in India: analysis of three large prospective multicentric cohorts. J Perinatol 2019; 39:13-19. [PMID: 31485016 PMCID: PMC8075971 DOI: 10.1038/s41372-019-0471-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the direct causes of mortality among preterm neonates <33 weeks' gestation by examining three large multisite, hospital-based datasets in India. METHOD Three prospective hospital-based datasets: the National Neonatal Perinatal Database (NNPD) of India, the Delhi Neonatal Infection Study (DeNIS) cohort, and the Goat Lung Surfactant Extract (GLSE)-Plus cohort were analyzed to study the causes of death among preterm neonates of less than 33 weeks' gestation admitted to the participating tertiary care hospitals in India. RESULTS A total of 8024 preterm neonates were admitted in the three cohorts with 2691 deaths. Prematurity-related complications and sepsis contributed to 53.5% and 19.8% of deaths in the NNPD cohort, 51.0% and 25.0% in the DeNIS cohort, and 39.7% and 40.9% in GLSE-Plus cohort, respectively. CONCLUSIONS Nearly a quarter (20-40%) of preterm neonates less than 33 weeks' gestation admitted to Indian NICUs died of sepsis. The study results have implications for health policies targeted to reduce the neonatal mortality rate in India.
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Affiliation(s)
- Kajal Jain
- 0000 0004 1767 6103grid.413618.9All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M. Jeeva Sankar
- 0000 0004 1767 6103grid.413618.9All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sushma Nangia
- grid.415723.6Lady Hardinge Medical College (LHMC), New Delhi, India
| | - Vishnu Bhat Ballambattu
- 0000000417678301grid.414953.eJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Venkataseshan Sundaram
- 0000 0004 1767 2903grid.415131.3Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Siddharth Ramji
- 0000 0004 1767 743Xgrid.414698.6Maulana Azad Medical College (MAMC), New Delhi, India
| | - Nishad Plakkal
- 0000000417678301grid.414953.eJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Praveen Kumar
- 0000 0004 1767 2903grid.415131.3Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Jain
- 0000 0004 1767 743Xgrid.414698.6Maulana Azad Medical College (MAMC), New Delhi, India
| | - Sindhu Sivanandan
- 0000000417678301grid.414953.eJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sreenivas Vishnubhatla
- 0000 0004 1767 6103grid.413618.9All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Harish Chellani
- 0000 0004 1803 7549grid.416888.bVardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashok Deorari
- 0000 0004 1767 6103grid.413618.9All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vinod K. Paul
- 0000 0004 1767 6103grid.413618.9All India Institute of Medical Sciences (AIIMS), New Delhi, India ,0000 0001 0683 2228grid.454780.aNational Institution for Transforming India (NITI Aayog), Government of India, New Delhi, India
| | - Ramesh Agarwal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Priyadarshi M, Sankar MJ, Gupta N, Agarwal R, Paul V, Deorari A. Efficacy of daily supplementation of 800 IU vitamin D on vitamin D status at 6 months of age in term healthy Indian infants. J Perinatol 2018; 38:1566-1572. [PMID: 30185932 DOI: 10.1038/s41372-018-0216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Most authorities recommend daily supplementation of 400 IU vitamin D for all term healthy neonates throughout infancy, however this dose was shown to be inadequate in an earlier study from our institution. We planned to evaluate if supplementation of 800 IU/day in term Indian infants would reduce the prevalence of vitamin D insufficiency (VDI) at 6 months of age. METHODS In a prospective study, we supplemented 800 IU/day of vitamin D in 70 term infants from birth till 6 months of age. Serum 25-hydroxy cholecalciferol [25(OH)D] was measured at birth and 6 months for all infants; and at 6, 10 and 14 weeks of age in subsets of 23 infants each. The primary outcome was prevalence of VDI (defined as serum 25(OH)D level < 50 nmol/L) at 6 months of age. RESULTS A total of 58 out of 70 (83%) infants were followed up until 6 months of age. The median (nmol/L; IQR) serum 25(OH)D at birth and 6 months of age was 25 (12.5-35) and 92.5 (72.5-137.5), respectively. The prevalence of VDI at birth was 91.3% (63/69), which reduced to 6.9% (4/58) at 6 months of age. However, four infants (6.9%, 95% CI 1.9-16.7) developed vitamin D excess (serum 25(OH)D 250-375 nmol/L) requiring reduction of the dose of supplementation. No infant developed vitamin D toxicity (serum 25(OH)D > 375 nmol/L). CONCLUSIONS Daily supplementation of 800 IU of vitamin D resulted in vitamin D sufficiency in most term healthy infants at 6 months of age but with potential risk of toxicity.
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Affiliation(s)
- Mayank Priyadarshi
- Division of Neonatology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Mari Jeeva Sankar
- Division of Neonatology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Agarwal
- Division of Neonatology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Paul
- Division of Neonatology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Deorari
- Division of Neonatology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
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Kamath-Rayne BD, Thukral A, Visick MK, Schoen E, Amick E, Deorari A, Cain CJ, Keenan WJ, Singhal N, Little GA, Niermeyer S. Helping Babies Breathe, Second Edition: A Model for Strengthening Educational Programs to Increase Global Newborn Survival. Glob Health Sci Pract 2018; 6:538-551. [PMID: 30287531 PMCID: PMC6172134 DOI: 10.9745/ghsp-d-18-00147] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/27/2018] [Indexed: 12/03/2022]
Abstract
The revised neonatal resuscitation curriculum updates not only the science of resuscitation but also the educational and implementation approaches needed to further enhance neonatal survival, including promoting ongoing practice to retain skills and linkages with quality improvement initiatives. Background: Helping Babies Breathe (HBB), a skills-based program in neonatal resuscitation for birth attendants in resource-limited settings, has been implemented in over 80 countries since 2010. Implementation studies of HBB incorporating low-dose high-frequency practice and quality improvement show substantial reductions in fresh stillbirth and first-day neonatal mortality. Revision of the program aimed to further augment provider and facilitator skills and address gaps in implementation with the goal of improving neonatal survival. Methods: The Utstein Formula for Survival—Medical Science X Educational Efficiency X Local Implementation = Survival—provided a framework for the revisions. The 2015 Neonatal Resuscitation Consensus on Science and Treatment Recommendations by the International Liaison Committee on Resuscitation informed scientific updates, which were harmonized with the 2012 World Health Organization Basic Newborn Resuscitation Guidelines. Published literature and program reports, consensus guidelines on reprocessing equipment, systematic collection of suggestions from frontline users, and responses to a semistructured online questionnaire informed educational/implementation revisions. Links to maternal care were added. Draft materials underwent Delphi review and field testing in India and Sierra Leone. An Utstein-style meeting of stakeholders identified key actions for successful implementation. Results: Scientific revisions included expectant management of infants with meconium-stained amniotic fluid, limitation of suctioning, and initiating and continuing effective ventilation until spontaneous respirations. Frontline users (N=102) suggested augmented simulation methods to build confidence and competence and additional guidance for facilitators on implementation. Users identified a need for sufficient practice during the workshop, systematized ongoing practice, and enough simulators for participants. Field trials refined approaches to self-reflection, feedback and debriefing, and quality improvement. Utstein meeting stakeholders validated the importance of quality improvement and use of data to improve outcomes. Conclusions: The second edition of HBB provides a newer paradigm of learning for providers that incorporates workshop practice, self-reflection, and feedback and debriefing to reinforce learning as well as the promotion of mentorship and development of facilitators, systems for low-dose high-frequency practice in facilities, and quality improvement related to neonatal resuscitation.
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Affiliation(s)
- Beena D Kamath-Rayne
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA, and Perinatal Institute and Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Eileen Schoen
- Division of Life Support, American Academy of Pediatrics, Itasca, IL, USA
| | - Erick Amick
- Division of Life Support, American Academy of Pediatrics, Itasca, IL, USA
| | - Ashok Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Carrie Jo Cain
- World Hope International, Alexandria, VA, USA and Freetown, Sierra Leone
| | - William J Keenan
- Division of Neonatology, Saint Louis University, St. Louis, MO, USA
| | - Nalini Singhal
- Division of Neonatology, University of Calgary, Alberta, Canada
| | - George A Little
- Division of Neonatology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Susan Niermeyer
- Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA
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Deorari A, Livesley N. Delivering Quality Healthcare in India: Beginning of Improvement Journey. Indian Pediatr 2018; 55:735-737. [PMID: 30345974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ashok Deorari
- WHO Collaborating Centre for Education and Research in Newborn Care, Department of Pediatrics, AIIMS, New Delhi, India.
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Deorari A, Darlow BA. Preventing sight-threatening ROP: a neonatologist's perspective. Community Eye Health 2017; 30:50-52. [PMID: 29434436 PMCID: PMC5806218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ashok Deorari
- Professor: Department of Paediatrics, WHO Collaborating Centre for Training and Research in Newborn Care), All India Institute Of Medical Sciences, New Delhi, India
| | - Brian A Darlow
- Emeritus Professor of Paediatrics: University of Otago, Christchurch, New Zealand
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Agarwal N, Bathwal S, Kriplani A, Deorari A, Bhatla N. Intra-amniotic instillation of surfactants for the prevention of neonatal respiratory distress syndrome following preterm delivery. Int J Gynaecol Obstet 2016; 135:196-199. [DOI: 10.1016/j.ijgo.2016.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/22/2016] [Accepted: 07/22/2016] [Indexed: 11/29/2022]
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Deorari A, Gilbert C. Controlling Visual Loss From Retinopathy of Prematurity in India. Indian Pediatr 2016; 53 Suppl 2:S73-S75. [PMID: 27915309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ashok Deorari
- WHO Collaborating Centre for Education and Research in Newborn Care,Department of Pediatrics, AIIMS, New Delhi; and *International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Sampath N, Singh A, Gopalakrishnan S, Thukral A, Sankar MJ, Agarwal R, Jaryal AK, Deorari A, Paul VK. Description and Validation of a Novel Method of Measuring Pharyngeal Pressure in New-born. Indian J Physiol Pharmacol 2016; 60:200-204. [PMID: 29809378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED Study background: Measurement of delivered pharyngeal pressure during continuous positive airway pressure (CPAP) therapy is not in routine practice due to lack of a simple and affordable technique of intrapharyngeal pressure measurement. To overcome the lack of the gold standard solid-state catheter-tip pressure measurement technology in our set up, we improvised a novel method of pressure measurement and tested its validity in a simulated pharynx. METHODS A low-cost pressure transducer was improvised by attaching an orogastric tube to its one end. The other end of the orogastric tube was sealed into an artificial pharynx - a 20 ml syringe. The pressure transducer readings were compared with that obtained by a digital manometer attached to the tip of the syringe. Bland-Altman statistic was used to quantify the measurement reliability of the novel method against the digital manometer. Effect of tube length on the measurement agreement was also studied. The developed technique was applied in new-borns. RESULTS & CONCLUSION Pressures measured by this technique were in good agreement with that obtained using a digital manometer. This technique has the potential to be used as an alternative to catheter-tip pressure transducers for bedside pharyngeal pressure measurement in new-born babies, especially in under-resourced setups.
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Gilbert C, Wormald R, Fielder A, Deorari A, Zepeda-Romero LC, Quinn G, Vinekar A, Zin A, Darlow B. Potential for a paradigm change in the detection of retinopathy of prematurity requiring treatment. Arch Dis Child Fetal Neonatal Ed 2016; 101. [PMID: 26208954 PMCID: PMC4717385 DOI: 10.1136/archdischild-2015-308704] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Wormald
- Cochrane Eyes and Vision Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Alistair Fielder
- Division of Optometry & Visual Science, City University, London, UK
| | - Ashok Deorari
- Department of Neonatology, All India Institute of Medical Sciences, Delhi, India
| | | | - Graham Quinn
- Division of Ophthalmology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Anand Vinekar
- Department of Pediatric Retina, Narayana Nethralaya PostgraduateInstitute of Ophthalmology, Bangalore, India
| | - Andrea Zin
- Department of Clinical Research, Child and Maternal Health, Instituto Fernandes Figueira, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Brian Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
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Yoshida S, Martines J, Lawn JE, Wall S, Souza JP, Rudan I, Cousens S, Aaby P, Adam I, Adhikari RK, Ambalavanan N, Arifeen SE, Aryal DR, Asiruddin S, Baqui A, Barros AJ, Benn CS, Bhandari V, Bhatnagar S, Bhattacharya S, Bhutta ZA, Black RE, Blencowe H, Bose C, Brown J, Bührer C, Carlo W, Cecatti JG, Cheung PY, Clark R, Colbourn T, Conde-Agudelo A, Corbett E, Czeizel AE, Das A, Day LT, Deal C, Deorari A, Dilmen U, English M, Engmann C, Esamai F, Fall C, Ferriero DM, Gisore P, Hazir T, Higgins RD, Homer CS, Hoque DE, Irgens L, Islam MT, de Graft-Johnson J, Joshua MA, Keenan W, Khatoon S, Kieler H, Kramer MS, Lackritz EM, Lavender T, Lawintono L, Luhanga R, Marsh D, McMillan D, McNamara PJ, Mol BWJ, Molyneux E, Mukasa GK, Mutabazi M, Nacul LC, Nakakeeto M, Narayanan I, Olusanya B, Osrin D, Paul V, Poets C, Reddy UM, Santosham M, Sayed R, Schlabritz-Loutsevitch NE, Singhal N, Smith MA, Smith PG, Soofi S, Spong CY, Sultana S, Tshefu A, van Bel F, Gray LV, Waiswa P, Wang W, Williams SLA, Wright L, Zaidi A, Zhang Y, Zhong N, Zuniga I, Bahl R. Setting research priorities to improve global newborn health and prevent stillbirths by 2025. J Glob Health 2015; 6:010508. [PMID: 26401272 PMCID: PMC4576458 DOI: 10.7189/jogh.06.010508] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
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Affiliation(s)
- Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - José Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Norway
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, London, UK ; Saving Newborn Lives, Save the Children, Washington, USA
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, USA
| | - Joăo Paulo Souza
- Department of Social Medicine, Ribeirăo Preto School of Medicine, University of Săo Paulo, Brazil
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh Medical School, Scotland, UK
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Peter Aaby
- Bandim Health Project, Indepth Network, Guinea-Bissau
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Sudan
| | | | | | - Shams Ei Arifeen
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Dhana Raj Aryal
- Department of Neonatology Paropakar Maternity and women's Hospital, Nepal
| | - Sk Asiruddin
- TRAction Bangladesh Project, University Research Co., LLC
| | | | - Aluisio Jd Barros
- Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas, Brazil
| | - Christine S Benn
- Research Center for Vitamins and Vaccines, Statens Serum Institut, and University of Southern Denmark/Odense University Hospital, Denmark
| | - Vineet Bhandari
- Program in Perinatal Research, Yale University School of Medicine, USA
| | - Shinjini Bhatnagar
- Pediatric Biology Centre, Translational Health Science and Technology Institute, India
| | | | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert E Black
- Institute of International Programs, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Carl Bose
- The University of North Carolina at Chapel Hill School of Medicine, USA
| | | | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Germany
| | | | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Brazil
| | - Po-Yin Cheung
- Departments of Pediatrics, Pharmacology & Surgery, University of Alberta, Canada
| | | | - Tim Colbourn
- University College London Institute for Global Health, UK
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan, USA
| | - Erica Corbett
- Independent consultant maternal health research, Rwanda
| | - Andrew E Czeizel
- Foundation for the Community Control of Hereditary Diseases, Hungary
| | - Abhik Das
- Biostatistics and Epidemiology, RTI International, USA
| | | | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases National Institute of Health, USA
| | | | - Uğur Dilmen
- Pediatrics and Neonatology, Yıldırım Beyazıt University Medical Faculty, Turkey
| | - Mike English
- Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, UK and KEMRi-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Cyril Engmann
- Newborn Health, Family Health Division, The Bill & Melinda Gates Foundation and the University of North Carolina Schools of Medicine and Public Health, USA
| | | | - Caroline Fall
- International Paediatric Epidemiology; Affiliations: Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | | | - Peter Gisore
- School of Medicine, Child Health and Pediatrics, Moi University, Kenya
| | - Tabish Hazir
- Children's Hospital, Pakistan Institute of Medical Sciences, Pakistan
| | - Rosemary D Higgins
- Eunice Kennedy Shriver NICHD Neonatal Research Network, Pregnancy and Perinatology, Branch, National Institute of Health, USA
| | - Caroline Se Homer
- Centre for Midwifery, Child and Family Health, University of Technology, Sydney, Australia
| | - D E Hoque
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Lorentz Irgens
- University of Bergen and Norwegian Institute of Public Health, Norway
| | - M T Islam
- Japan International Cooperation Agency (JICA), Bangladesh
| | | | | | | | - Soofia Khatoon
- Paediatrics and Head of Department Shaheed Suhrawardy Medical College, Bangladesh
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Karolinska Institute, Sweden
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Eve M Lackritz
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), USA
| | - Tina Lavender
- University of Manchester School of Nursing Midwifery & Social Work, University of Manchester, UK
| | | | | | | | | | - Patrick J McNamara
- Departments of Paediatrics & Physiology, University of Toronto; Physiology & Experimental Medicine program, Hospital for Sick Children, Toronto, Canada
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, the Netherlands
| | | | - G K Mukasa
- International Baby Food Action Network, Uganda
| | - Miriam Mutabazi
- STRIDES for Family Health, Management Sciences for Health, Uganda
| | - Luis Carlos Nacul
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Margaret Nakakeeto
- Kampala Children's Hospital Limited and Childhealth Advocacy International, Uganda
| | - Indira Narayanan
- United States Agency for International Development /Maternal and Child Health Integrated Program, USA
| | | | - David Osrin
- Wellcome Trust Senior Research Fellow in Clinical Science, Institute for Global Health, University College London, UK
| | - Vinod Paul
- All India Institute of Medical Sciences, India
| | | | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | - Mathuram Santosham
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, USA
| | | | | | | | - Mary Alice Smith
- Environmental Health Science Department, University of Georgia, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Sajid Soofi
- Department of Pediatrics & Child Health, Women & Child Health Division, Aga Khan University, Pakistan
| | - Catherine Y Spong
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA
| | - Shahin Sultana
- National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare, Bangladesh
| | - Antoinette Tshefu
- Kinshasa School of Public Health, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - Frank van Bel
- Department of Neonatology, University of Utrecht, the Netherlands
| | | | - Peter Waiswa
- Division of Global Health, Karolinska Institutet, Sweden
| | - Wei Wang
- School of Medical Sciences, Edith Cowan University, Australia and School of Public Health, Capital Medical University, China
| | | | - Linda Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | | | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, China
| | - Nanbert Zhong
- Developmental Genetics Laboratory, New York State Institute for Basic Research in Developmental Disabilities, USA
| | | | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Moxon SG, Lawn JE, Dickson KE, Simen-Kapeu A, Gupta G, Deorari A, Singhal N, New K, Kenner C, Bhutani V, Kumar R, Molyneux E, Blencowe H. Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth 2015; 15 Suppl 2:S7. [PMID: 26391335 PMCID: PMC4577807 DOI: 10.1186/1471-2393-15-s2-s7] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preterm birth is the leading cause of child death worldwide. Small and sick newborns require timely, high-quality inpatient care to survive. This includes provision of warmth, feeding support, safe oxygen therapy and effective phototherapy with prevention and treatment of infections. Inpatient care for newborns requires dedicated ward space, staffed by health workers with specialist training and skills. Many of the estimated 2.8 million newborns that die every year do not have access to such specialised care. METHODS The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" (or factors that hinder the scale up) of maternal-newborn intervention packages. For this paper, we used quantitative and qualitative methods to analyse the bottleneck data, and combined these with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for inpatient care of small and sick newborns. RESULTS Inpatient care of small and sick newborns is an intervention package highlighted by all country workshop participants as having critical health system challenges. Health system building blocks with the highest graded (significant or major) bottlenecks were health workforce (10 out of 12 countries) and health financing (10 out of 12 countries), followed by community ownership and partnership (9 out of 12 countries). Priority actions based on solution themes for these bottlenecks are discussed. CONCLUSIONS Whilst major bottlenecks to the scale-up of quality inpatient newborn care are present, effective solutions exist. For all countries included, there is a critical need for a neonatal nursing cadre. Small and sick newborns require increased, sustained funding with specific insurance schemes to cover inpatient care and avoid catastrophic out-of-pocket payments. Core competencies, by level of care, should be defined for monitoring of newborn inpatient care, as with emergency obstetric care. Rather than fatalism that small and sick newborns will die, community interventions need to create demand for accessible, high-quality, family-centred inpatient care, including kangaroo mother care, so that every newborn can survive and thrive.
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Affiliation(s)
- Sarah G Moxon
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Saving Newborn Lives, Save the Children, Washington DC, 20036, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Saving Newborn Lives, Save the Children, Washington DC, 20036, USA
| | - Kim E Dickson
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, 10017, NY, USA
| | - Aline Simen-Kapeu
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, 10017, NY, USA
| | - Gagan Gupta
- UNICEF, India 73, Lodi Estate New Delhi, 110 003, India
| | - Ashok Deorari
- Department of Pediatrics, WHO Collaborating Centre for Education & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nalini Singhal
- University of Calgary, 2888, Shaganappi Trail NW, Calgary, Alberta, T3B 6C8, Canada
| | - Karen New
- The University of Queensland, Brisbane, Qld, 4029, Australia
| | - Carole Kenner
- Council of International Neonatal Nurses, Dean of School of Nursing, Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628-0718, USA
| | - Vinod Bhutani
- Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA, 94305-5101, USA
| | - Rakesh Kumar
- India Ministry of Health & Family Welfare, Government of India, Nirman Bhawan, New Delhi, 110108, India
| | | | - Hannah Blencowe
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Saving Newborn Lives, Save the Children, Washington DC, 20036, USA
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Moxon SG, Ruysen H, Kerber KJ, Amouzou A, Fournier S, Grove J, Moran AC, Vaz LME, Blencowe H, Conroy N, Gülmezoglu A, Vogel JP, Rawlins B, Sayed R, Hill K, Vivio D, Qazi SA, Sitrin D, Seale AC, Wall S, Jacobs T, Ruiz Peláez J, Guenther T, Coffey PS, Dawson P, Marchant T, Waiswa P, Deorari A, Enweronu-Laryea C, Arifeen S, Lee ACC, Mathai M, Lawn JE. Count every newborn; a measurement improvement roadmap for coverage data. BMC Pregnancy Childbirth 2015; 15 Suppl 2:S8. [PMID: 26391444 PMCID: PMC4577758 DOI: 10.1186/1471-2393-15-s2-s8] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. Methods In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. Results ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. Conclusions The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.
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Abstract
BACKGROUND Between 6% and 15% of neonates develop hyperbilirubinaemia requiring treatment. Successful management of neonatal hyperbilirubinaemia relies on prevention and early treatment, with phototherapy being the mainstay of treatment. Oral zinc has been reported to decrease the serum total bilirubin (STB), presumably by decreasing the enterohepatic circulation. OBJECTIVES To determine the effect of oral zinc supplementation compared to placebo or no treatment on the incidence of hyperbilirubinaemia in neonates during the first week of life and to assess the safety of oral zinc in enrolled neonates. SEARCH METHODS We searched CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE (1966 to November 30, 2014), and EMBASE (1990 to November 30, 2014). SELECTION CRITERIA Randomised controlled trials were eligible for inclusion if they enrolled neonates (term and preterm) to whom oral zinc, in a dose of 10 to 20 mg/day, was initiated within the first 96 hours of life, for any duration until day seven, compared with no treatment or placebo. DATA COLLECTION AND ANALYSIS We used the standard methods of The Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. MAIN RESULTS Only one study met the criteria of inclusion in the review. This study compared oral zinc with placebo. Oral zinc was administered in a dose of 5 mL twice daily from day 2 to day 7 postpartum. The drug was administered into the mouth of the infant by the plastic measure provided with the bottle or with a spoon. Incidence of hyperbilirubinaemia, defined as serum total bilirubin (STB) ≥ 15 mg/dL, was similar between groups (N = 286; risk ratio (RR) 0.94, 95% confidence interval (CI) 0.58 to 1.52). Mean STB levels, mg/dL, at 72 ± 12 hours were comparable in both the groups (N = 286; mean difference (MD) -0.20; 95% CI -1.03 to 0.63). Although the duration of phototherapy in the zinc group was significantly shorter compared to the placebo group (N = 286; MD -12.80, 95% CI -16.93 to -8.67), the incidence of need for phototherapy was comparable across both the groups (N = 286; RR 1.20; 95% CI 0.66 to 2.18). Incidences of side effects like vomiting (N = 286; RR 0.65, 95% CI 0.19 to 2.25), diarrhoea (N = 286; RR 2.92, 95% CI 0.31 to 27.71), and rash (N = 286; RR 2.92, 95% CI 0.12 to 71.03) were found to be rare and statistically comparable between groups. AUTHORS' CONCLUSIONS The limited evidence available has not shown that oral zinc supplementation given to infants up to one week old reduces the incidence of hyperbilirubinaemia or need for phototherapy.
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Affiliation(s)
- Satish Mishra
- Lifeline Advanced Neonatal CentreNeonatologyCool RoadJalandharPanjabIndia144001
| | - Aminderjit Cheema
- Lifeline Advanced Neonatal CentreNeonatologyCool RoadJalandharPanjabIndia144001
| | - Ramesh Agarwal
- All India Institute of Medical SciencesDepartment of PediatricsNew DelhiIndia
| | - Ashok Deorari
- All India Institute of Medical SciencesDepartment of PediatricsNew DelhiIndia
| | - Vinod Paul
- All India Institute of Medical SciencesDepartment of PediatricsNew DelhiIndia
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Thukral A, Lockyer J, Bucher SL, Berkelhamer S, Bose C, Deorari A, Esamai F, Faremo S, Keenan WJ, McMillan D, Niermeyer S, Singhal N. Evaluation of an educational program for essential newborn care in resource-limited settings: Essential Care for Every Baby. BMC Pediatr 2015; 15:71. [PMID: 26105072 PMCID: PMC4479066 DOI: 10.1186/s12887-015-0382-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Essential Care for Every Baby (ECEB) is an evidence-based educational program designed to increase cognitive knowledge and develop skills of health care professionals in essential newborn care in low-resource areas. The course focuses on the immediate care of the newborn after birth and during the first day or until discharge from the health facility. This study assessed the overall design of the course; the ability of facilitators to teach the course; and the knowledge and skills acquired by the learners. Methods Testing occurred at 2 global sites. Data from a facilitator evaluation survey, a learner satisfaction survey, a multiple choice question (MCQ) examination, performance on two objective structured clinical evaluations (OSCE), and pre- and post-course confidence assessments were analyzed using descriptive statistics. Pre-post course differences were examined. Comments on the evaluation form and post-course group discussions were analyzed to identify potential program improvements. Results Using ECEB course material, master trainers taught 12 facilitators in India and 11 in Kenya who subsequently taught 62 providers of newborn care in India and 64 in Kenya. Facilitators and learners were satisfied with their ability to teach and learn from the program. Confidence (3.5 to 5) and MCQ scores (India: pre 19.4, post 24.8; Kenya: pre 20.8, post 25.0) improved (p < 0.001). Most participants demonstrated satisfactory skills on the OSCEs. Qualitative data suggested the course was effective, but also identified areas for course improvement. These included additional time for hands-on practice, including practice in a clinical setting, the addition of video learning aids and the adaptation of content to conform to locally recommended practices. Conclusion ECEB program was highly acceptable, demonstrated improved confidence, improved knowledge and developed skills. ECEB may improve newborn care in low resource settings if it is part of an overall implementation plan that addresses local needs and serves to further strengthen health systems. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0382-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anu Thukral
- All India Institute of Medical Sciences, New Delhi, India.
| | | | - Sherri L Bucher
- Indianappolis Indianna University School of Medicine, ., USA.
| | | | - Carl Bose
- University of North Carolina, Chapel Hill, USA.
| | - Ashok Deorari
- All India Institute of Medical Sciences, New Delhi, India.
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Venkatnarayan K, Sankar MJ, Deorari A, Krishnan A, Paul VK. A micro-costing model of neonatal intensive care from a tertiary Indian unit: feasibility and implications for insurance. Indian Pediatr 2015; 51:215-7. [PMID: 24736910 DOI: 10.1007/s13312-014-0376-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To calculate and compare costs of neonatal intensive care by micro-costing and gross-costing methods. METHODS The costs of resources of a tertiary care neonatal intensive care unit were estimated by the two methods to arrive at specific costs per diagnosis related categories for 33 neonates followed-up prospectively. RESULTS Gross-costing as compared to micro-costing resulted in higher cost per bed (Rs 6315 vs. Rs 4969) and wide variations of costs (-34.8% to +13.4%). Intensity of interventions, relative stay in neonatal intensive care unit compared to the step-down nursery, and total length of hospital admission accounted for these variations. CONCLUSION Estimates based on micro-costing arrived in this study may be used as a starting point in developing assumptions for insurance models covering neonatal intensive care.
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Affiliation(s)
- Kannan Venkatnarayan
- WHO Collaborating Center for Training and Research in Newborn Care and ICMR Center for Advanced Research in Newborn Health, Newborn Health Knowledge Center, Division of Neonatology, Department of Pediatrics, and *Department of Preventive and Social Medicine, AIIMS, New Delhi, India. Correspondence to: Prof Vinod Paul, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India.
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Affiliation(s)
- Ashok Deorari
- Newborn Health Knowledge Center (NHKC), Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, 110029, India,
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Campbell-Yeo M, Deorari A, McMillan DD, Singhal N, Vatsa M, Aylward D, Scotland J, Kumar P, Joshi M, Kalyan G, Dol J. Educational barriers of nurses caring for sick and at-risk infants in India. Int Nurs Rev 2014; 61:398-405. [PMID: 25131708 DOI: 10.1111/inr.12121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To gain ideas and information from healthcare providers to optimize the education and clinical practices of nurses caring for sick or at-risk newborns in India. BACKGROUND Improving infant survival has been identified as a Millennium Development Goals; however, India still faces many challenges with 3.1 million neonatal deaths and 2.6 million stillbirths annually. Skilled nursing care has been associated with decreased morbidity and mortality in newborns. However, core competencies in newborn care education and training are lacking for nurses. METHODS Qualitative data were collected from 12 focus groups with 101 newborn care providers from three areas of India as well as from a 2-day stakeholders' meeting. Data analysis was undertaken using descriptive and thematic content analysis. RESULTS Perceived challenges included limited manpower and high nurse turnover, lack of access to evidence-based orientation to newborn care and problems with access to appropriate learner-based, neonatal training. Relevant, ongoing education opportunities, led by nursing leaders were identified to be important solutions. CONCLUSION Findings provide insight into the current healthcare system in India with specific reference to the nursing care of at-risk newborns. There is a lack of existing resources to provide standardized and specific orientation curricula for nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY Policy makers in health and education need to: support and enact learner-based orientation and continuing educational opportunities as well as ongoing competency-based education programmes; encourage nurse leader involvement and support; and provide sustainable system-related supports. Nurses and other health providers need to work together to influence government policy.
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Affiliation(s)
- M Campbell-Yeo
- School of Nursing, Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada; Maternal Newborn Program, IWK Health Centre, Halifax, Nova Scotia, Canada
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Sasi A, Chandrakumar N, Deorari A, Paul VK, Shankar J, Sreenivas V, Agarwal R. Neonatal self-inflating bags: achieving titrated oxygen delivery using low flows: an experimental study. J Paediatr Child Health 2013; 49:671-7. [PMID: 23819690 DOI: 10.1111/jpc.12269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2013] [Indexed: 11/28/2022]
Abstract
AIM To determine delivered O2 concentration (dFiO2) during manual inflations using neonatal self-inflating resuscitation bags (SIBs) at oxygen (O2) flow rates <1 L/min. METHODS This experimental study, determined dFiO2 during 216 sets of manual inflations at different O2 flow rate (L/min; 0.2, 0.4, 0.6, 0.8, 1.0 and 5.0), controlling peak inspiratory pressures (PIP; cm of H2O; 10-15, 15-20 and 20-25), inflation rates (per min; 30, 40 and 60), with and without O2 reservoir using two SIBs--the Laerdal infant resuscitator (240 mL) and Ambu Mark IV resuscitator (300 mL). A leak proof circuit connecting the SIB in series with pressure transducer, O2 analyzer and test lung was used. All possible combinations were tested four times each. The dFiO2 with each possible combination was compared using generalised estimating equation. RESULTS The mean dFiO2 with SIB even without reservoirs varied with rates and PIP from 75 to 93% at O2 flow rate of 5 L/min. At 1 L/min flow itself, 65-85% O2 is delivered. The dFiO2 was reduced to approximately 40% with flow of 0.2 L/min, PIP 20-25 cmH2O and inflations 40-60 per min. CONCLUSION During manual breaths using neonatal SIBs, the delivered O2 concentration of nearly 40% is attained at clinically used inflation pressures and rates by using lower flows. A graded increase in O2 delivery from 40 to 99% was obtained with flow varying from 0.2 to 5 L/min and addition of reservoir. However, even at such low flows, reduction in O2 concentration below 40% was unattained.
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Affiliation(s)
- Arun Sasi
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Chawla D, Deorari A. Oxygen saturation targets in extremely premature neonates. Natl Med J India 2013; 26:163-165. [PMID: 24476165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Deepak Chawla
- Department of Paediatrics Government Medical College Hospital Chandigarh
| | - Ashok Deorari
- Division of Neonatology, Department of Paediatrics All India Institute of Medical Sciences, New Delhi -
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Kandraju H, Murki S, Subramanian S, Gaddam P, Deorari A, Kumar P. Early routine versus late selective surfactant in preterm neonates with respiratory distress syndrome on nasal continuous positive airway pressure: a randomized controlled trial. Neonatology 2013; 103:148-54. [PMID: 23235135 DOI: 10.1159/000345198] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/15/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm neonates with respiratory distress syndrome (RDS) benefit from early application of nasal continuous positive airway pressure (nCPAP). However, it is not clear whether surfactant should be administered early as a routine to all such infants or later in a selective manner. OBJECTIVE It was the aim of this study to compare the efficacy of early routine versus late selective surfactant treatment in reducing the need for mechanical ventilation (MV) during the first week of life among moderate-sized preterm infants with RDS being supported by nCPAP. METHODS Infants born at 28(0/7) to 33(6/7) weeks of gestation with RDS and on nCPAP were randomly assigned within the first 2 h of life to early routine surfactant administration by the InSurE technique (early surfactant group) or to late selective administration of surfactant (late surfactant group). The primary outcome was need for MV in the first 7 days of life. RESULTS Among 153 infants randomized to early (n = 74) or late surfactant (n = 79) groups, the need for MV was significantly lower in the early surfactant group (16.2 vs. 31.6%; relative risk 0.41, 95% confidence interval 0.19-0.91). The incidence of pneumothorax (1.9 vs. 2.3%) and the need for supplemental O2 at 28 days (2.7 vs. 8.9%) were similar in the two groups. CONCLUSION Early routine surfactant administration within 2 h of life as compared to late selective administration significantly reduced the need for MV in the first week of life among preterm infants with RDS on nCPAP.
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Agarwal R, Virmani D, Jaipal M, Gupta S, Sankar MJ, Bhatia S, Agarwal A, Devgan V, Deorari A, Paul VK, Toteja GS. Poor zinc status in early infancy among both low and normal birth weight infants and their mothers in Delhi. Neonatology 2013; 103:54-9. [PMID: 23128541 DOI: 10.1159/000342227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 07/28/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Low birth weight (LBW) infants are at high risk of zinc deficiency, but there is a paucity of data on their zinc status. OBJECTIVE To evaluate zinc status of LBW (BW <2,500 g) and normal birth weight (NBW; BW ≥ 2,500 g) infants at birth and in early infancy. METHODS A total of 339 infants (LBW, n = 220; NBW, n = 119) were enrolled, and venous blood samples of mother-infant dyad were taken within 48 h of birth. Infants' levels were repeated between 2 and 10 months of age. Serum zinc levels were estimated using an inductively coupled plasma mass spectrometer. Primary outcome was zinc deficiency, defined as serum zinc <65 µg/dl. RESULTS Zinc results were available for 182 LBW and 103 NBW infants at birth and for 100 LBW and 66 NBW infants at follow-up with a median postnatal age of 14 and 15.5 weeks, respectively. Median zinc levels were low and comparable at birth as well as at follow-up, with zinc deficiency being present in 51.0% of LBW and 42.4% of NBW infants at birth and in 79.0% of LBW and 66.7% of NBW infants at follow-up. Zinc levels decreased significantly in both groups from birth to follow-up, irrespective of zinc multivitamin supplementation. Zinc levels of infants with BW <2,000 g at follow-up were significantly lower compared to infants with higher BW. CONCLUSION Zinc status was poor in many infants at birth irrespective of BW. Zinc status worsened significantly during early infancy, with infants with BW <2,000 g having the lowest zinc levels.
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Affiliation(s)
- Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Delhi, India. drshuchitagupta @ gmail.com
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Agarwal R, Virmani D, Jaipal ML, Gupta S, Gupta N, Sankar MJ, Bhatia S, Agarwal A, Devgan V, Deorari A, Paul VK. Vitamin D status of low birth weight infants in Delhi: a comparative study. J Trop Pediatr 2012; 58:446-50. [PMID: 22529320 DOI: 10.1093/tropej/fms013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate vitamin D status of preterm and term low birthweight (LBW) and term normal birth weight (NBW; weight ≥ 2500 g) infants at birth and in early infancy. METHODS We enrolled 220 LBW and 119 NBW infants along with their mothers. Blood samples of both infants and mothers were taken within 48 h of birth, and that of infants were repeated at 3 months. Serum levels of calcium, phosphate, alkaline phosphatase, 25 hydroxyvitamin D (25OHD) and parathormone (PTH) were estimated using standard tests. Our primary outcome was vitamin D deficiency (VDD; serum 25OHD <20 ng/ml in mothers and <15 ng/ml in infants). Other outcomes were raised PTH (>46 pg/ml), raised AlkP (>120 U/l in mothers and 420 U/l in infants), and clinical rickets. FINDINGS VDD was present in 186 (87.3%) of LBW and 103 (88.6%) of NBW infants at birth, and in 77 (60.6%) of LBW and 55 (71.6%) of NBW infants at a median corrected age of 12 and 15 weeks, respectively. VDD was almost universal (93-97%) among mothers of both groups. Raised PTH was present in 138 (63.6%) of LBW and 48 (41.4%) of NBW infants at birth, and in 58 (45.7%) of LBW and 38 (49.3%) of NBW infants at follow-up. Clinical rickets was present in 17 (13.4%) of LBW and 4 (4.9%) of NBW infants at 12-14 weeks of corrected age. CONCLUSIONS High prevalence of VDD in LBW as well as NBW infants with clinical rickets at an early age underlines the need to study the effect of various vitamin D supplementation regimens in these infants to identify the optimal dose.
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Affiliation(s)
- Ramesh Agarwal
- All India Institute of Medical Sciences, Department of Pediatrics, Kasturba Hospital and Swami Dayanand Hospital, New Delhi 110029, India.
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Abstract
Retinopathy of prematurity (ROP) occurs due to abnormal proliferation of retinal vessels. The most important risk factors which predispose to development of ROP include oxygen therapy, anemia needing blood transfusion, sepsis and apnea. Very low birth weight neonates, those born at ≤ 32 week of gestation and other preterm neonates with risk factors must be screened for ROP. As a general rule first screening should be done at 1 month of postnatal age. If screening detects ROP not needing treatment follow up should be planned according to location and stage of ROP. Better visual outcomes are observed with earlier treatment at lower threshold. Peripheral retinal ablation with diode laser under adequate analgesia and sedation is the preferred method for treatment of severe ROP. Guidelines regarding the procedure of dilatation, ophthalmic examination and treatment (if required) have been provided in the protocol. Close co-operation between the ophthalmologist and neonatologist is essential for successful management of ROP.
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Affiliation(s)
- Deepak Chawla
- Department of Pediatrics, Government Medical College, Chandigarh, India
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Deorari A, Thukral A, Aruna V. Online learning in newborn health: a distance learning model. Natl Med J India 2012; 25:31-32. [PMID: 22680321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Ashok Deorari
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Abstract
BACKGROUND Phototherapy is the mainstay of treatment of neonatal hyperbilirubinaemia. The commonly used light sources for providing phototherapy are special blue fluorescent tubes, compact fluorescent tubes and halogen spotlights. However, light emitting diodes (LEDs) as light sources with high luminous intensity, narrow wavelength band and higher delivered irradiance could make phototherapy more efficacious than the conventional phototherapy units. OBJECTIVES To evaluate the effect of LED phototherapy as compared to conventional phototherapy in decreasing serum total bilirubin levels and duration of treatment in neonates with unconjugated hyperbilirubinaemia. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2010, Issue 1), MEDLINE (1966 to April 30, 2010) and EMBASE (1988 to July 8, 2009). Handsearches of the proceedings of annual meetings of The European Society for Paediatric Research and The Society for Pediatric Research were conducted through 2010. SELECTION CRITERIA Randomised or quasi-randomised controlled trials were eligible for inclusion if they enrolled neonates (term and preterm) with unconjugated hyperbilirubinaemia and compared LED phototherapy with other light sources (fluorescent tubes, compact fluorescent tubes, halogen spotlight; method of administration: conventional or fibreoptic). DATA COLLECTION AND ANALYSIS We used the standard methods of The Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. MAIN RESULTS Six randomised controlled trials met the inclusion criteria for this review. Four studies compared LED and halogen light sources. Two studies compared LED and compact fluorescent light sources. The duration of phototherapy (six studies, 630 neonates) was comparable in LED and non-LED phototherapy groups (mean difference (hours) -0.43, 95% CI -1.91 to 1.05). The rate of decline of serum total bilirubin (STB) (four studies, 511 neonates) was also similar in the two groups (mean difference (mg/dL/hour) 0.01, 95% CI -0.02 to 0.04). Treatment failure, defined as the need of additional phototherapy or exchange blood transfusion (1 study, 272 neonates), was comparable (RR 1.83, 95% CI 0.47 to 7.17). Side effects of phototherapy such as hypothermia (RR 6.41, 95% CI 0.33 to 122.97), hyperthermia (RR 0.61, 95% CI 0.18 to 2.11) and skin rash (RR 1.83, 95% CI 0.17 to 19.96) were rare and occurred with similar frequency in the two groups. AUTHORS' CONCLUSIONS LED light source phototherapy is efficacious in bringing down levels of serum total bilirubin at rates that are similar to phototherapy with conventional (compact fluorescent lamp (CFL) or halogen) light sources. Further studies are warranted for evaluating efficacy of LED phototherapy in neonates with haemolytic jaundice or in the presence of severe hyperbilirubinaemia (STB ≥ 20 mg/dL).
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Affiliation(s)
- Praveen Kumar
- Postgraduate Institute of Medical Education and ResearchDepartment of Pediatrics, Neonatal UnitChandigarhIndia16012
| | - Deepak Chawla
- Government Medical College and HospitalDepartment of PediatricsChandigarhIndia160030
| | - Ashok Deorari
- All India Institute of Medical SciencesDepartment of PediatricsNew DelhiIndia110029
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47
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Abstract
Patent ductus arteriosus (PDA) is a major morbidity in preterm infants, especially in extremely premature infants less than 28 weeks. The clinical signs and symptoms of PDA in preterm infants are non specific and insensitive for making an early diagnosis of significant ductal shunting. Functional echocardiography is emerging as a new valuable bedside tool for early diagnosis of hemodynamically significant ductus, even though there are no universally accepted criteria for grading the hemodynamic significance. Echocardiography has also been used for early targeted treatment of ductus arteriosus, though the long term benefits of such strategy are debatable. The biomarkers like BNP and N terminal pro BNP are currently under research as diagnostic marker of PDA. The primary mode of treatment for PDA is pharmacological closure using cyclo-oxygenase inhibitors with closure rate of 70-80%. Oral ibuprofen is emerging as a better alternative especially in Indian scenario where parenteral preparations of indomethacin are unavailable and side effects are comparatively lesser. Though pharmacological closure of PDA is an established treatment modality, there is still lack of evidence for long term benefits of such therapy as well as there is some evidence for the possible adverse effects like increased ROP and BPD rates, especially if treated prophylactically. Hence, it is prudent to reserve treatment of PDA to infants with clinically significant ductus on the basis of gestation, birth weight, serial echocardiography and clinical status to individualize the decision to treat.
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Affiliation(s)
- Arun Sasi
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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48
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Abstract
OBJECTIVE To compare gain in knowledge and skills of neonatal resuscitation using tele-education instruction vs conventional classroom teaching. STUDY DESIGN This randomized controlled trial was conducted in the tele-education facility of a tertiary care center. In-service staff nurses were randomized to receive training by tele-education instruction (TI, n=26) or classroom teaching (CT, n=22) method from two neonatology instructors using a standardized teaching module on neonatal resuscitation. Gain in knowledge and skill scores of neonatal resuscitation were measured using objective assessment methods. RESULT Age, educational qualification and professional experience of the participants in two groups were comparable. Pre-training mean knowledge scores were higher in TI group (8.3±1.7 vs 6.6±1.4, P=0.004). However, skill scores were comparable in the two groups (11.7±3 vs 10.3±2.9, P=0.13). Training resulted in a significant and comparable gain in knowledge scores (4.2±2.2 vs 5.3±1.7; P=0.06) and skills scores (4.5±3.3 vs 5.0±3.1, P=0.62) in both the groups. The post-training knowledge scores (TI: 12.5±1.7 vs CT: 12.0±1.7, P=0.37) and the post-training skill scores (TI: 16.0±0.5 vs CT: 15.6±2.5, P=0.55) were comparable in the two groups. However, the post-training scores, adjusted for baseline knowledge scores, were statistically higher in the in-person group compared with the telemedicine group (knowledge: 12.46±0.03 vs 12.16±0.01, P=0.00; skills: 15.6±2.5 vs 16.0±2.8, P=0.00). The quantum of lower scores in the telemedicine group was only 2% for knowledge and 6% for skills. This difference was felt to be of only marginal importance. Satisfaction scores among trainees and instructors were comparable in the two groups. CONCLUSION Tele-education offers a feasible and effective alternative to conventional training in neonatal resuscitation among health-care providers.
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Affiliation(s)
- A Jain
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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49
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Abstract
Hypocalcemia is a frequently observed clinical and laboratory abnormality in neonates. Ionic calcium is crucial for many biochemical processes including blood coagulation, neuromuscular excitability, cell membrane integrity, and many of the cellular enzymatic activities. Healthy term infants undergo a physiological nadir in serum calcium levels by 24-48 h of age. This nadir may drop to hypocalcemic levels in high-risk neonates including infants of diabetic mothers, preterm infants and infants with perinatal asphyxia. The early onset hypocalcemia which presents within 72 h requires treatment with calcium supplementation for at least 72 h. In contrast, late onset hypocalcemia usually presents after 7 days and requires longer term therapy.
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Affiliation(s)
- Ashish Jain
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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50
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Abstract
Seizures in the newborn period constitute a medical emergency. Subtle seizures are the commonest type of seizures occurring in the neonatal period. Myoclonic seizures carry the worst prognosis in terms of long-term neurodevelopmental outcome. Hypoxic-ischemic encephalopathy is the most common cause of neonatal seizures. Multiple etiologies often co-exist in neonates and hence it is essential to rule out common causes such as hypoglycaemia, hypocalcemia, and meningitis before initiating specific therapy. A comprehensive evidence based approach for management of neonatal seizures has been described in this protocol.
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Affiliation(s)
- Jeeva M Sankar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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